OUTCOME AFTER SURGICAL DISLOCATION AS SALVAGE PROCEDURE FOR ADVANCED HIP OSTEOARTHRITIS

Abstract

Introduction: Femoroacetabular Impingement (FAI) with more or less subtle abnormality of the hip anatomy and function may contribute to the early development of osteoarthritis (OA). Surgical dislocation as well as arthroscopy of the hip joint are effective and save tools to correct these anatomic deformities. Good clinical results could be achieved predominantly in patients not exceeding grade I OA. The aim of the presented study was to evaluate the clinical and radiological outcome of patients that were treated by open surgical hip dislocation for more advanced OA of the hip joint (> grade I).

Patients and Methods: This is a prospective clinical trial on the outcome of patients after surgical hip dislocation. We report on 45 hip joints (41 patients, 16 m, 25 f) that were treated in our institution by offset-correction (removal of osseous bumps at the femoral head-neck junction) and/or labral surgery for FAI. All patients were evaluated prospectively before and after surgery (Harris Hip Score, radiographic parameters, arthro-MRI).

Results: The mean follow up (FU) was 45 months (range: 12–102 months). 9 hips underwent total hip replacement in the further course of FU for persisting pain. In the remaining hips a significant pain reduction but no amelioration of hip range of motion could be accomplished. In 90% of the cases, a good correlation between preop-erative arthro-MRT findings and intraoperative labrum and cartilage assessment could be demonstrated. Concerning the outcome, no patient or radiographic factors could be identified that were strongly associated with failure after surgical dislocation.

Discussion and Conclusion: Our data suggests that even patients with more advanced osteoarthritis of the hip may benefit from the surgical dislocation approach as a hip salvage procedure. However, the high number of conversion to total hip arthroplasty indicates, that the indication for hip salvage should stay restricted. Patient or radiographic factors indicative of failure could not be identified. In the future and with more sophisticated molecular MRI techniques such as delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) concrete prediction models could be implemented to preoperatively assess hip cartilage in order to sort out patients who will not profit from salvage surgery for advanced OA due to FAI.